Homeschool Registration Form

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Leidy's Younger Homeschool PE Program 2025 - 2026

Summary

Push The Rock Homeschool PE Program is an engaging two hours with group games, sports instruction and team time in which kids are taught biblical principles and how to apply it to their lives.

Date/Time: (all sessions include a field trip on the last day of each session)
Session 1: Tuesdays, 9/9/25 - 10/21/25 10am to 12pm (no class on 10/7)
Session 2: Tuesdays, 11/4/25 - 12/16/25, 10am to 12pm (no class on 11/25)
Session 3: Tuesdays, 1/13/26 - 2/17/26, 10am to 12pm
Session 4: Tuesdays, 3/3/26 - 4/7/26, 10am to 12pm

Ages: 6 - 10 years old
please note that 10 year olds can choose between the younger class or the older class depending on what works best for each family.

Location: Immanuel Leidy's Church (273 W Cherry Ln, Souderton, PA 18964)

Cost: $75 per child per session. You may register for just one session, or multiple sessions. If you register for just for one session, you will have an opportunity to register for other sessions at a later time.

**A one day guest pass is $15 and is an option in this form for those that would like to tryout a class before signing up for the full session. Please note that we ask that you email the director, Mitch Thomas (mthomas@pushtherock.org) to arrange a visit date.

Parent / Guardian Information

Parent/Guardian First Name: Parent/Guardian Last Name: Suffix: Email: Cell Phone: (Please opt in for text messaging below so we can keep you informed about event details like weather cancellations) Address: City: State: Zip: -

Emergency Contact Information

Please provide contact information for another adult other than the parent/guardian filling out this form (ex: spouse, relative, friend). In case of an emergency, we will first reach out to the Parent/Guardian listed above.

Emergency Contact Name Emergency Contact Phone Number

# of Participants

Number of Children Attending If you have a coupon, please enter code here (case-sensitive): Relation of Registrant to Attendees:

Waiver Statement:

I have read and agree to Push The Rock's General Release agreement.

Yes, I agree

required fields

Home School Refund Policy

A refund of 50% of the registration cost will be given to any child that chooses to not attend a session prior to its start. If a child (or parent) chooses to back out in the middle of a session, NO refund will be given. If a Doctor’s note is provided regarding an injury or illness that keeps that child from participating, a refund can be given for the remaining classes that will be missed.